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Author
Topic: Slight Viral load Increase (Read 19089 times)

I thought I had started a thread already in regards to my test results, but I couldn't find it. For those interested, I received my viral load in the mail today. The original draw in 5/16/06, was incomplete, and had to be re-done.

Anyway, the viral load came back as 288 from a previous <50 . I am not really all that concerned, But I will call the doctor on Monday, and see if anything additional needs to be done at this point. This was also the highest viral load , since starting meds on October of 2003. My doctor gets concerned if it gets above the 400 range. Other results for the 5/16/06 test, were CD4 -350, up from 270 in 2/14/06. All other blood test fine.

I have also posted, all my stats on the bottom of my post, so anyone can see what progress has been made,(ups and downs) since starting on meds.

I guess you shouldn't be too concerned about this for the time being. Your results seem to show you had a few occasional blips but always returned undetectable so it might the same story repeating here.

I believe they use the tube with that material, or whatever it is at the bottom.

The blood is sent out, from his office. My doctor uses several testing facilities.I know that Quest Diagnostics is one of them. I think Baycore (sp is another one) I have seen these facilities names written on the wall, and the type of tubes required for the differant tests. I never really questioned it before...But perhaps I should, just for my own knowledge.

What I donít get is my numbers have always been great, never had a detected viral load. Yet I'm hardly able to get out of the house. When I do I usually have a killfoile moment. I.e. have an accident and need to rush back home. Have been admitted to the hospital more time than I can count.

AND YOUR WORKING!

Thursday my doctor suggested I take a drug holiday because of whatís happening to my body. It scares me to think of going off the drugs.

Oh Yes, I am still working, But I can assure you, it's getting a little more difficult as time goes on. By the time I am done with my work week, about all I can do is sleep the first day off, after that , I am somewhat OK again. Plus, I don't have that difficult of a job.(Physical or strenuous)But the graveyard shift has it own physical demands in itself. I transferred out of the physical type job , back in October of 04. It was too demanding, and the neuropathy was too much, to be on my feet 8 hours a day.

Otherwise, I am certainly not feeling all that great at times, but I am still functioning as best I can....... For now !! I still have never had a Killfoile moment with broccoli. bands ! I am alright in that department. I don't think I have had the craps since starting on meds. My main problems is the PN, and the muscle ache in the upper legs. Also the neck pain (which comes and goes) If it wasn't for these things, and the occasional fatigue, I would be feeling half-way decent. Yes, I do have my "aids days" or "aids daze" depending on how you want to look at it !!

I also want to add something here. Last night I had one if my wierd dreams.I had dreamt, that I was opening my bottle of meds, and throwing the pills down the toilet. Then My partner walked in and said what are you doing ? And like usual, I woke up before I knew what I was going to say to him. But I remember during this dream, I felt terrified and yet relieved at the same time. (if that makes any sense )

I would love to be able to take a break from the meds, but starting off at a t-cell count of 16 pretty much rules that out. I also realize that my numbers will never be great. My current meds are working overtime, just to get me where I am at now.

Believe me, I understand when you say "enough is enough" I sometimes think that myself. And now ..... I'm starting to dream it. and I have only been on meds 32 months now ! And then I think of others, that have been on meds 5,10 15, plus years....

I am sure somewhere down the road, my doctor will also say, that its time to take a break from the meds, and to be quite honest, I don't know how I will respond, when that day arrives, or if I make that decision prior to that.

The viral load test gives good results. However, be aware that less than 50 copies doesn't = no virus. As someone who knows a lot about HIV, I am sure you know that.

Studies done on people who are undetectable show there are 2-20 copies per ml (which is bloody low compared to 2,000,000). Therefore your viral load levels are bouncing around the detectability limit of the test. That's good news. A virological failure would manifest by an ever-increasing viral load back as high as the pre-medication level. I am sure you knew that too. I honestly don't think it means much unless it comes back as increasing from test to test. Given that you have had a low 100s test and it went back down again, I would predict the same will happen again.

Keep doing whatever you are doing and checking with your doctor.

R

« Last Edit: June 10, 2006, 05:41:00 PM by HIVworker »

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NB. Any advice about HIV is given in addition to your own medical advice and not intended to replace it. You should never make clinical decisions based on what anyone says on the internet but rather check with your ID doctor first. Discussions from the internet are just that - Discussions. They may give you food for thought, but they should not direct you to do anything but fuel discussion.

My Doc told me that if we had a viral load test done every single day, we'd see blips very often and that it varies just like our cd4's vary (that's a general analogy by the way). Variance on a daily basis that we don't see occurs a lot.

The main thing is you always go below 50 again, so like the others said, don't worry too much about it.

The reason I was curious about which tubes they use for the VL sample is that I read (actually a couple of times) that if they use the tubes with the plug thing in the bottom, and if, the sample is spun down and shipped off for later testing, then false positives were found to be fairly common.

I have searched for this, (I'm sure I read it from Dr. Gallant over at Hopkins--it was discovered in one of the drug trials a couple of years ago) and I can't seem to find it.

When I switched doctors a couple of years ago, I asked too, and sure enough he confirmed that the tube with the plug in the bottom should not be used, for the same reason.

Now, having rambled on about that for far too long, let me echo what everyone has already said. This is quite likely a blip. R's comment was exactly what I was thinking, (but never could have worded it as clearly).

RAB

(Who is still real curious about the tube difference thing, cause his last doctor used those tubes and he never could get <50, but now has never been >50 with his new doctor and lab. Which doesn't use the tube with the plug in the bottom, doesn't ship the blood off to some other city, but does the test right there in the hospital.)

I've mentioned this before; you and I both came down with PCP in Oct. 2003. I was in and out of the hospital for the month of Oct, started meds (Combivir and kaletra) in Nov, went back into the hospital, quit meds, and back home from the hospital for good in Dec. Then I started Reyetaz, Norvir, Epivir and Viread (now Truvada). I became undetectable in Mar, 2004 and my CD4 count continues to go up. But, like Terry, I have never been able to go back to work.

As far as I can tell, working is the biggest difference between you and me.

I don't honestly know how you do it. I certainly think there are more pluses than minuse about going back to work but maybe the workload does affect your numbers.

Your numbers keep bouncing around so lets see what they do next month.

Rocky (RAB) may be on to something, talking about the plug in the bottom of the tube thingy. I think Rocky and Gerry go hand-in-hand, like Mutt and Jeff. One always asks a question and the other always has the answer. The two of them have helped me more than once and they did it again this time. I am going to print out Gerry's "answers" and take them to my Dr and show her. I'm curious what she says.

In the meantime, I'll be hoping your VL takes a u-turn and continues a downward motion.

Hi RayYour #s do seem to jump around a bit. But you've been above 50 before then dropped back down, so maybe thats the way it goes with some meds?I work nights too and it is a killer. And I'm in cold air cond around 65 degrees so that messes me up too. Even 75 can be too cold to me, I love the heat.Has your doc ever thought to switch to sustiva? It seems folks on sustiva have better labs. Or maybe it just seems that way to me? I still gripe that if they can get the vl to under 50, then why cant they just wipe it totally out at that point.Maybe some day....Take care,Randy

The tube you are refering to is a PST (Plasma seperating tube)the "pluggy thing" is a seperating gel, when the tube is put into the centerfuge and spins the "pluggy thing" moves to the midddle of the tube sererating the blood from the plasma.

i think all of my 'tubes' have a gelly thing in the bottom.... but they are different colors on the tube tops..... i can only presume they are testing right, but for the purposes of viral load... what color combo should we be looking for?

(note... worried wells using any of the discourse will be highly scolded... this is not a forum to fear your fears)

First of all, I want to thank everyone for your responses. Eric, Jena I am doing fine. I am not in a panic attack mode, I have had several of these increases over the past 32 months, so I'm kind of used to them. I am doing fine, thanks for asking, I really do appreciate it !!! This was the largest one , since starting therapy. It doesn't pay to get all upset about it anyways, because it isn't going to change anything.

On the issue of the vials, I will certainly bring this up with the Doctor, when I speak to him, But there is no doubt, that I have seen the tubes, that have this plug,( or substance)about a half inch deep within the tube.And there are others that are used, that do not have this in the bottom of the tube. Gerry, thanks for those links, I have also printed them out ! I never knew that.

---------------------------------------------------------------------------------------------------------On a separate issue here ( but related) after posting this, I finally decided to completely read the Special winter issue of " Positively Aware. I had mentioned, on the old threads, I had picked up this issue, along with other publications, from my doctors office, on my last visit. I never knew this publication existed, and was very impressed with what I had read. Another reason I started reading this issue was because of the thread started by "Londonguy" regarding HIV resistance, in this thread :

For those interested, if you can get this issue, I highly suggest reading it. There is tons of information in it. In the first article, was the mention of Tim Horn, and an article he wrote entitled "A PK PRIMER" . this article was in the Positively Aware, fall 2005 issue. You can also read it online by clicking on the links below:

This Article(Tim Horn's) can be read by clicking below: (adobe is NOT needed for this one)

Hi Ray thnks for all the links on the subject, will be interesting to read them. Regarding these Viral blips, it seems to be a rather common occourance. Your Cd4's still climbing, that is definalty good news

It'll be interesting to see which tube they are using. I guess in the big scheme of things these blips really don't matter, I was just thinking it might be the reason you are seeing them.

Now, the fact some of the tubes are the PST (thanks Jan for the correct name ) when they do the draws doesn't mean the VL is one of them. For instance the lipid panel they draw for is collected in a PST.

But I'm still going to be curious. These tests aren't cheap, and I don't think it's unreasonable for us to expect the labs to be following correct procedure and handling. It they don't then the possibility of inaccurate results (misleading results) means we aren't really getting what is being paid for. (I'm thinking of KCMetro's recent experience.)

Dingo; they way I found out which tube was for the VL was I simply asked the phlebotomist. You're right there are usually anywhere from 6 - 8+ tubes, so the only way to know for sure is to ask.

RAB

P.S. Thanks Gerry for finding that. I was searching in the patient side and couldn't find it. I didn't think to look in the clinician side. Is this even important in your opinion or am I just being curious about something that isn't really significant?

Ray I would tell you what tubes my Doc uses, but I have my eyes closed while I am squeezing my husbands hand till it turns blue... The worst part is that "sucking noise" I here coming from my arm. I am waiting for the sound to change to the sound of a slurrpy running out at the very end. That empty sucking sound. "Opps" sorry, we took to much Eric.

All this talk about the type of tubes used. I've never even noticed there are different ones. The last couple of times I've had blood drawn they've had a trainee drawing my blood. Her hands were shaking so bad last time I ended up with a huge bruise. I guess I will pay more attention from now on. I hate it!

Here's something that might help put this into perspective for you. Sometimes people who are worried about being infected will get viral load (PCR) tests done and fairly often they get false positive results. This is in people who go on to reliably test hiv negative on the ELISA antibody tests.

In other words, even people who are hiv negative can get detectable results on viral load tests. This is why they are not approved for diagnostic purposes - they return far too many false positive results. Your low (but detectable) result is most likely a false positive. I'd bet the farm on it.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Is this even important in your opinion or am I just being curious about something that isn't really significant?

Here's and excerpt from the November 2005 HIV Hopkins Report written by Dr. Gallant on this topic. I think it explains the issues better. Their new site requires registration now to access the entire newsletter, so I copied the relevant sections.

"...recent data have revealed that incorrect processing of blood samples is the cause of a large proportion of what are now viewed as false positive viral load results. Although viral load assays are supposed to be drawn using EDTA tubes ("lavender-" or "purple-top" tubes), most laboratories have been using plasma preparation tubes (PPT or "serum separator" tubes) for the convenience and safety of laboratory personnel. These tubes combine a spray-dried anticoagulant and a polyester material that separates the components of blood after centrifugation. Exposure to HIV and other blood-borne pathogens is reduced, as samples can be collected, processed, and transported in situ. After centrifugation, the tubes are frozen and sent to the lab for analysis. Unfortunately, samples processed in this manner are more likely to show false positive viral load results than samples processed using EDTA tubes, the risk of which is associated with prolonged storage prior to centrifugation and freezing of the specimen in situ [Murphy R, et al.12th CROI, Boston, MA, 2005, Abstract 738; Alvarez D, et al. 3rd IAS, Rio de Janeiro, Brazil, 2005, Abstract MoPe15.2C06]. HIV-infected lymphocytes can continue to release virus into the plasma, creating artifactual elevations in viral load. It is now recommended that EDTA tubes be used to process blood specimens for viral load measurement, or that PPT tubes, if used, be spun and plasma separated within 6 hours of phlebotomy. The plasma, not the entire tube, can then be frozen and stored for up to 72 hours. Most commercial laboratories are now directing their personnel to process specimens in this manner, but the change is recent and has not been universal...As commercial labs begin to change the way the process viral load specimens, the accuracy of the tests should improve. In the meantime, clinicians should speak to the labs they use to find out whether the processing changes have been implemented at the local level."

Bailey:

Quote

I go to quest diagnostics.

I believe the problem is less of an issue with Quest's bDNA assay (Versant version 3.0) as it is with Roche's more sensitive RT-PCR assay (Amplicor Version 1.5).

Okay, now this tube thing is gonna be on my brain the next time I get blood drawn.

Last time, I remember getting a pale yellow-topped tube drawn for my labs. It wasn't yellow-topped like the normal SST (for routine chemistry), but was large -- much like a type and screen for the blood bank.

I've never drawn a tube like that, and I assume it was for viral serology. Next time i'll have to check if it has the gunk @ the bottom.

Thanks Gerry . I printed out all 8 pages from the Hopkins Hiv report. And now that my memory is fairly clear, The Purple or lavender colored top was the one that was used a week and a half ago for the viral load test. I remember this now, as it was the only tube drawn ! So, That tube would be the EDTA tube, if I am correct.

And according to the article, If the PPT tubes are used they should be spun within 6 hours of phhlebotomy.

That it should be spun within 4 hours, Or am I reading or misunderstanding something differant here.Ensure that unspun specimens arrive within 4 hours of collection, and before 1:30 pm. If not, centrifuge, freeze plasma, and send the next working day.

Hey Ray,No, you're reading it correctly. When we have blood drawn here, it is sent to a lab in California. If you go in and have the draw done after 2 p.m., or on Thursdays or Fridays, you can bet on bad results.

On another note, you say you are having pain in the legs and neck. Do I remember that you are taking a statin as well? These are very much like the effects I encountered when taking Vytorin, which is Zetia, a fat blocker, and Zocor, a statin.

You said your other blood work came out fine, so this is probably a moot point. But did your doc check liver function and CPKs? If you are taking a statin, this could be augmenting your muscular pain.

And the interesting part of that is, I only take the Zocor for five days on two days off, this was my decision. Probably not a wise one, but anyway,When I am off the Zocor, thats when I have less neck and body pain. Not completely diminished, but it is lessoned, especially by the second day off the Zocor.

Liver function tests are done every 3 months. And the results on those tests are always good !

Without getting into the discussion about the test tubes, I want to just tell you that small incremental changes that keep going in the up direction with the vl, should be watched with people like you and me. The reason is that our virus is very adept at mutation, and to let it go on the same velocity as one with a new infection, would surely be madness and result in theraputic failure. I agree with you that you need to stay vigilant and keep an awareness that with an accelerated vl growth, our nieve CD4s are not as capable of fighting this increase, and in the end, we can get very damaging results if we don't pay attention to even small changes that come on over a three to four month period. Many of the people on this forum are not dealing with the same issues we are, as they have not had the impact of Opportunistic Infections that leave an immune system permanently damaged. I wish I could somehow get that information to stick in people's brains. Unfortunately there are even many doctors that don't understand this concept.

Stay vigilant and don't let that vl grow any more. It can cascade very rapidly if not taken care of now!

In Love and Support.

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The Bible contains 6 admonishments to homosexuals,and 362 to heterosexuals.This doesn't mean that God doesn't love heterosexuals, It's just that they need more supervision.Lynn Lavne

And according to the article, If the PPT tubes are used they should be spun within 6 hours of phhlebotomy.

Yes, if the PPT (white top) tube is used (the one with the plug thingy), it should be spun as soon as possible. Not only that, it is recommended that after spinning, the clear plasma part should be separated out of the tube before it's frozen. It is the plasma that is tested for the viral load. What seems to happen when this is not done is the cellular component that is spun to the bottom of the tube, even though it remains separated from the plasma by the plug thingy, can "leak" some viral particles from the white blood cells that are trapped at the bottom into the plasma part and this can get reported as "detectable" virus. By separating the plasma immediately after spinning and storing the plasma frozen alone, this problem is avoided.

If the EDTA (lavender tube) is used, it is also spun, but since there is no plug, the tech does need to separate the plasma from the cells at the bottom immediately (otherwise, if this gets stored without separating, the cells get mixed into the plasma again, like it was not spun at all). So in this situation, the plasma gets stored separately and immediately after spinning, and would not have the same problem as the PPT.

John:

Quote

Last time, I remember getting a pale yellow-topped tube drawn for my labs. It wasn't yellow-topped like the normal SST (for routine chemistry), but was large -- much like a type and screen for the blood bank.

That yellow-top tube is called ACD and is another tube that can be used for viral load. The difference is the anticoagulant in it is liquid (rather than solid, as in the EDTA tubes above (both the PPT and lavender tubed contain EDTA as anticoagulants). It is processed very similar to the lavender tube (i.e., it is spun and the plasma is separated immediately for storage). The only difference is because the anticoagulant is liquid, it adds a little volume to the blood that it is mixed with, so it may underestimate the viral load measurement.

Not intending to make this discussion too technical, but I hope this clarifies the questions about tubes, tops and bottoms

I've been thinking more about your situation now that I'm not too sleep-deprived. Were you planning on getting another test done sooner rather than later, and perhaps trying another genotype resistance test (though at this point, the VL is too low for the resistance test to be accurate)? Have you considered making a switch if you continue to see some more blips along the road, such as maybe using a boosted PI in place of Viramune (and perhaps even getting rid of the Ziagen or Viread at some point if the switch is successful)? This is not meant to cause you any concern. Just exploring the possible scenarios and the decision-making they tend to create down the road (knowing fully well that you've been through this decision-making road before when even less information was known about the different combos).

Lets see if I can do this all over again, without it getting deleted, and zapped ito thin air !! My internet connection keeps dropping off, because I am not typing fast enough I know there is a setting here somewhere to prevent that from happenning, just got to find it...

At this point, the doctor does not believe, that getting another test, is necessary,because of the very low blip. My next blood test is scheduled for August 15,06. Although, I am now wondering, if I shouldn't move it up sooner anyways, and just be a little more demanding, for my own piece of mind. If I decide to get another test prior to August 15th, I will certainly let you know.

As far as the Phenotype/ genotype, I have yet to have had either one of these these test done. My insurance covers one of those test, and I will have to pay out of pocket for the other one, which is not an issue at this point, if that is the case. I would prefer to have both test, when/should that become necessary.

On a couple of occasions that doctor has suggested that possibility, of dropping the viramune and starting a PI. It had been just about 32 months on this regimen. ( Slightly less time with the Viread) And I would probably love to get rid of the Ziagen. As far as my own thoughts, on making a switch of regemens, I have no problem in dealing with this, when this becomes necessary. But I understand the "decision making" especially, when it starts staring at ya , right in the face.

Gerry, I do appreciate, your comments and your thoughts on this.While I can understand the possibility of others maybe having a tough time discussing this, I prefer to !! I may have lived with HIV 20 plus years, but overall I know very little. I am always trying to get info, it can be a little mind-boggling at times, but it keeps the cob-webs from forming !!

Gerry, thanks again !! I will keep you updated on things as they happen.

If it is determined that what you are experiencing are nothing more than "blips" then there might not be any clinical consequences to it. The problem is differentiating "blips" with early virologic failure, which may for all intents and purposes look like "blips" at the beginning. So how do you differentiate one from the other? At low detectable viral loads, you really cannot tell. This is complicated by the fact that the low viral loads such as yours will not allow for obtaining a resistance test (which needs a viral load at about 1000 to be reliable). But if this represented early treatment failure, you don't really want to get to the point when you have a high enough viral load to run a resistance test before deciding to intervene, because then you might end up with more resistance issues.

The other problem in your situation is you are on an "unconventional" combo (Viramune, 3TC, Ziagen, Viread). Let's assume worst case scenario (which I'm not saying is what's going on) in which the repeated viral load detectability represents early treatment failure, what might happen if you continue the same regimen? We know that Viramune is one mutation away (K103N) from full viral resistance. If that happens in your case, you will be left with the 3 nukes that we now know should not be used by themselves because the combination apparently lowers the genetic barrier to nuke resistance. That could pave the way to development of more resistance, including 3TC resistance (M184V) and Ziagen and Viread resistance (K65R). This scenario is probably what makes me most concerned about your particular situation in the setting of repeated detectable viral load measurements.

So looking at your treatment history and numbers, I think it would be prudent to at least recheck the viral load again sooner rather than later. Getting a resistance test might still not be possible if the viral load continues to be low (and you don't need both genotype and phenotype tests; the genotype test usually suffices in your situation, but again, the viral load number may not allow it). If it is still detectable, I would suggest to seriously discuss some regimen changes with your doc, especially since you do have the option of switching to a different one.

One other thing to consider is to get a second professional opinion. You could write to Dr. Gallant at Hopkins (LINK) by including your treatment history and the labs as they appear on your signature and ask him what his recommendations are. You could also use the experts at thebody.com.

Welll, I will tell you what I think !! I think you convinced me to go ahead and make another appointment with the doctor ( much sooner) and get another viral load test. So, I will call him this Monday and get that arranged. Just let him know that I would feel better to have this test redone, And get into some srious discussion of regemen change, and the periodic "blips" that I am encountering.I will let you know, when the retest will be done, and the results of that test. I am not quite sure if insurance will pay for that or not, if not there is no problem right now for paying out of pocket, if need be. I really need to have some peace of mind here, so Gerry, you convinced me !! I've got to stay on top of things, it's too easy to fall into cracks...

My vl started jumping around a bit some months ago(hasn't reach 200 yet then goes back to undetect); was concerned at first, but ID doc has checked everything and says not to worry, we'll keep an eye on it. Taking me a few years, but learning to take things in stride and try not worry until need be...

I was sastified with the response. I had called my doctor today. and he still insist, that everything is ok, since it the viral load is less then 400, comparing my recent test and treatment history. He is also still not scheduling an earlier blood test, and insist that everything is fine, until next blood test on August 15,06. Just thought I would let you know this.

EDITED.--- I am still not through, I am going to insist in an earlier blood test, I don't care if I have to pay for it....

Thanks for the update. Not sure how to help you convince your doc to get another VL sooner. But I'm glad you're going to insist.

What do you think about Dr. G's other suggestion about intensifying Viramune/Truvada with AZT instead of Ziagen? This might be a more difficult choice considering that AZT has historically had more side effects than Ziagen. On the other hand, the other possibility is to go to a boosted PI and drop the Viramune and Ziagen. While thinking about a switch may not be imminent at this point, I believe Dr. G made a point about the difficulty with the unconventional combo that you are on in the face of intermittent detectable viral load. That is, what's happening now may not necessarily be the issue, but what might happen in the future if the detectable viremia continues to occur and the potential resistance patterns that might unfold due to it would be the more difficult question to answer.

Gerry

P.S. It was good of Dr. G to answer your question after he answered that pesky question on masturbation and weight gain

Thanks for your response. I greatly appreciate it !! I have thought about Dr. G's response about the Viramune, Truvada, AZT combination.(something to mention to my doctor). In the early part of 2004, I tried Trizivir, for a one month period, and decided to change, because of the effects of the AZT.Still working full time, it had made things somewhat difficult back then. I knew it was the AZT giving me problem, as I was already on Ziagen And Epivir.I am willing to give it a try again, and tough it out if I have to.I often wondered, if I just hadn't given the trizivir enough time back then. My doctor at that time was really hoping, that I would be able to tolerate the Trizivir. So, I am willing to give that a shot, somewhere down the road if need be. Certainly things to consider...

My doctor has also mentioned, about the boosted PI and dropping the Viramune. This had been mentioned a couple times within the past 8 months.Of course, this was all determinate on my results, trends.

Gerry, once again, thanks for your responses !! I am going to push for a another Viral load,hopefully within the next couple weeks, and we will see what those results produce.( Given the ammunition that I have.) Will keep you updated...

Managed to get my next appointment moved up from August 15th, to July 12th ! So, I feel good about that. I will let you know the results when they become available. I also want to have a serious consultation this time around !

Until 2 years ago, my viral load range was 1900-10,000. Finally, I asked the DR why I was never sick during this 7 year period. He didn't know. Offcourse LoL. So I hope you don't worry about the slight increase, as I'm sure you are not. But I would keep in mind that the goal is Undetectable...Just over two years ago I was reminding my DR that generally speaking, I have a high tolerance for most drugs. I'm 6'4'' 220 lbs. Shouldn't I have to take a higher dose? I asked...So he told me to take one extra kaletra pill a day. The next blood test revealed a ZERO viral load. I had also just recently started on fuzeon. I don't know for sure what did the trick, maybe a combo of the two things...the fuzeon and the extra kaletra???So it never hurts to ask questions and remind your DR about your own little quirks. I always go into the DR with a list, because once in there we have so much to cover I often would forget. There are no dumb questions, make your DR work. Think. It can pay off every once in a while!Now when they came out with the new kaletra, I'm back to the normal dose. My viral load has been at ZERO ever since.Good luck...your numbers are pretty damned good. Keep swinging!